2027 NOVA 4-H Summer Staff Application

2027 NOVA 4-H Summer Staff Application

Thank you for your interest in joining Team NOVA at the Northern Virginia 4-H Educational & Conference Center! It is because of YOU that over 1,600 youth will have an amazing experience at camp this summer.
As a full-time seasonal employee of the 4-H Center, you are expected to be on time and present for all of the camp activities and trainings events listed below. A typical week has a Sunday morning start time of 10am and Thursday evening end time of 6/7pm. All staff are required to attend all activites,meals, and programs from Morning Meeting to nightly debriefs, staff are not finished for the week until after Thursday afternoon debrief.

If you are unable to be present for the dates below, please strongly consider your ability to committ to working at the 4-H center this summer.

Review the list of TENTATIVE dates below and then check the appropriate choice below the list of dates. Please note that additional specialty camps will be added to the calendar as they are finalized.
- March 5 -6: TALT (unpaid, not required; all lodging and meals are covered by the Center)
- May 13th: Staff Move-In
- May 14 - 16: Lifeguard Training at the W.E. Skelton 4-H Center at Smith Mountain Lake (only required for those who will need to become certified lifeguards)
- May 16 - 20: State Staff Training at the Holiday Lake 4-H Educational Center (stipend pay; all certifications, travel, lodging, and meals are covered by the Center)
- May 23 - June 4: Center Staff Training at the NOVA 4-H Educational and Conference Center (please note this does not include "weekend" time off and a final schedule will be sent out prior to training, Exact training dates subject to some change)
- June 25th-27th: Tentative Cloverbud Camp Dates (paid, not required)
- July 25-29: Camp SMILE and Military Teen Adventure Camp

Employment Dates
As a full-time seasonal employee of the 4-H Center, you are expected to be on time and present for all of the camp activities and trainings events listed below. A typical week has a Sunday morning start time of 10am and Thursday evening end time of 6/7pm. All staff are required to attend all activites,meals, and programs from Morning Meeting to nightly debriefs, staff are not finished for the week until after Thursday afternoon debrief.

If you are unable to be present for the dates below, please strongly consider your ability to committ to working at the 4-H center this summer.

Review the list of TENTATIVE dates below and then check the appropriate choice below the list of dates. Please note that additional specialty camps will be added to the calendar as they are finalized.
- March 5 -6: TALT (unpaid, not required; all lodging and meals are covered by the Center)
- May 13th: Staff Move-In
- May 14 - 16: Lifeguard Training at the W.E. Skelton 4-H Center at Smith Mountain Lake (only required for those who will need to become certified lifeguards)
- May 16 - 20: State Staff Training at the W.E. Skelton 4-H Center at Smith Mountain Lake (stipend pay of $200; all certifications, travel, lodging, and meals are covered by the Center
- May 23 - June 4: Center Staff Training at the NOVA 4-H Educational and Conference Center (please note this does not include "weekend" time off and a final schedule will be sent out prior to training, Exact training dates subject to some change)
- June 25th-27th: Tentative Cloverbud Camp Dates (paid, not required)
- July 25-29: Camp SMILE and Military Teen Adventure Camp
What is your availability?
Please list any dates in which you have a conflict:

Personal Information
Name

First NameLast Name
Preferred Name (if applicable)
Pronouns
Camp Name (if applicable)
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Upload a Headshot/Image of Yourself

Cancelof
Permanent (Home) Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current (School) Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Position Sought
4-H Camping Unit (if applicable this is the county/city you have camped with as a camper/teen)

Education
Have you completed High School?
If not, do you have a GED?
Please list any college experience you have:
College or University Name:
Major or Area of Study:
Type of Degree:
Graduation Date:
(or expected date)
College or University Name:
Major or Area of Study:
Type of Degree:
Graduation Date:
(or expected date)

General
What date will you be available to start work?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Are you interested in becoming a Lifeguard?
Do you have reliable transportation?
T-Shirt Size

Work Experience:

Describe all paid, military, and applicable volunteer experience. Highlight your knowledge, skills, and abilities that best demonstrate your qualifications for this position.
1). Employer Name:
Employer Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Duties:
May we contact this employer?
2). Employer Name:
Employer Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
May we contact this employer?
3). Employer Name:
Employer Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
May we contact this employer?

References

Please list three references other than family members who can attest to your personality, character, and professional qualities.
IF YOU ARE A NEW STAFF MEMBER YOU MUST ALSO COMPLETE REFERENCE FORMS (see below for more details).
1). Reference Name:
Reference Phone:
Reference Email:
2). Reference Name:
Reference Phone:
Reference Email:
3). Reference Name:
Reference Phone:
Reference Email:
New Staff: In order to complete the application process, you will need to have three references who have knowledge of your personality, character, and professional qualifications complete an online reference form.

It will be your responsibility to contact your references and provide them with the link to our online reference form. This form can also be found in the linktree in our bio.

Reference Form: https://form.jotform.com/262664824111151

If you are asking a current staff member or one who has been on staff within the past 2 years, this can only account for 1 of your 3 references. If you have camped with Virginia 4-H in the past, we ask that at least one of your references be the Extension Agent you camped with.

Applications will NOT be considered and candidates will NOT be contacted for an interview until all three completed reference forms are received. Be sure to give your references plenty of time to complete this form and follow up with them to verify the completion.

Desired Position
Identify the positions of highest interest and share your experience in each area. Descriptions of positions can be found here (open in new tab). Some classes are still up in the air for which will actually be offered at camp and all staff will be cross trained in at least one additional class. If you have questions about what a position entails please email tatyana@nova4h.com
Position Title
Preference Ranking (1-4 with 1 holding the highest preference)
# of years participating in this activity
If none enter 0
# of years leading this activity
If none enter 0
List any certifications you currently have or have had for this activity:
Position Title
Preference Ranking (1-4 with 1 holding the highest preference)
# of years participating in this activity
If none enter 0
# of years leading this activity
If none enter 0
List any certifications you currently have or have had for this activity:
Position Title
Preference Ranking (1-4 with 1 holding the highest preference)
# of years participating in this activity
If none enter 0
# of years leading this activity
If none enter 0
List any certifications you currently have or have had for this activity:
Position Title
Preference Ranking (1-4 with 1 holding the highest preference)
# of years participating in this activity
If none enter 0
List any certifications you currently have or have had for this activity:
# of years leading this activity
If none enter 0
Are there any classes that you would feel uncomfortable teaching?
Are there any classes that you do not see listed that you would be interested in teaching?

Camp Skills

Please list your knowledge and skills in the following areas using the following values: 1 = no interest, 2 = no experience, 3 = some knowledge/interest, 4 = can assist with activity, 5 = can instruct/lead activity
Artistic Creation
Campfire Programs
Challenge Course/Low Ropes
Creative Arts/Fine Arts
Conflict Resolution
Emotional Intelligence
Forestry/Nature Education
Group Games
Initiative/Ability to Work Independently
Leadership Development
Debriefing
Medical Training
Outdoor Living Skills/Cooking
Paddling Sports
Programming
Shooting Sports
Song Leadership
Supervisory Skills
Swimming
Fitness/Health
Animal Science
Science, Technology, Engineering, and Math (STEM)

Your Soapbox...
Please tell us why you are interested in working at camp?
Please tell us why you are interested in the top position you selected? What experience or ideas do you have?
What does "Positive Youth Development" mean to you and how will you help us at camp fulfill the mission of creating avenues for "PYD" at camp?
Please describe your ability to work with others and independently resolve conflicts?
What is your perception and/or expectation of the role you applied for?
We strive for camp to be an inclusive environment for all, how will you work to ensure that all participants feel safe and included?
What qualities or skills do you possess that would make you the best candidate for a camp staff position?
What contributions would you bring to the camp staff?

License & Certifications

Include driver's license and other pertinent certifications (first aid, CPR, lifeguard, etc.)
Include: Certification Name, License or Reference Number, Expiration Date, and the Licensing Board:
(ex. CPR, #123456, exp: 8/2021, American Red Cross)
Include: Certification Name, License or Reference Number, Expiration Date, and the Licensing Board:
(ex. CPR, #123456, exp: 8/2021, American Red Cross)
Include: Certification Name, License or Reference Number, Expiration Date, and the Licensing Board:
(ex. CPR, #123456, exp: 8/2021, American Red Cross)
Include: Certification Name, License or Reference Number, Expiration Date, and the Licensing Board:
(ex. CPR, #123456, exp: 8/2021, American Red Cross)

Certification
For purposes of compliance with The Immigration Reform and Control Act, are you legally eligible for employment in the United States?
For purposes of compliance with Section 2.2-2903 of the code of Virginia, are you a veteran who received an honorable discharge and has (i) provided more than 180 consecutive days of full-time active-duty in the armed forces of the United States or reserve components thereof, including the National Guard, or (ii) has a service connected disability rating fixed by the United States Veteran Affairs?
I hereby certify that all entries in this application are true and complete, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part to any employment in the service of the 4-H Educational Center. I understand that all information on this application is subject to verification and I consent to criminal history background checks. I also consent to references and former employers and educational institutions listed being contacted regarding this application. I further authorize the 4-H Educational Center to rely upon the use, as it seems fit, any information received from contacts. Information contained on this application may be disseminated to other agencies, nongovernmental organizations or systems on a need-to-know basis for good cause shown as determined by the center head or designee.
Signature:
Today's Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Virginia Cooperative Extension programs and employment are open to all, regardless of age, color, disability, gender, gender identity, gender expression, national origin, political affiliation, race, religion, sexual orientation, genetic information, veteran status, or any other basis protected by law. An equal opportunity/affirmative action employer.

Individuals with disabilities desiring accommodations in the application process should notify Northern Virginia 4-H Educational Center at 434-248-5444 by the application deadline.
*TDD number is (800) 828-1120.
Should be Empty:

2027 NOVA 4-H Summer Staff Application

Employment Dates

Personal Information

Education

General

Work Experience:

References

Desired Position

Camp Skills

Your Soapbox...

License & Certifications

Certification